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This article offers four key lessons learned from a set of seven studies undertaken as part of the collection entitled, "Improving Maternal Health Measurement to Support Efforts toward Ending Preventable Maternal Mortality". These papers were aimed at validating ten of the Ending Preventable Maternal Mortality initiative indicators that capture information on distal causes of maternal mortality. These ten indicators were selected through an inclusive consultative process, and the research designs adhere to global recommendations on conducting indicator validation studies. The findings of these papers are timely and relevant given growing recognition of the role of macro-level social, political, and economic factors in maternal and newborn survival. The four key lessons include: 1) Strengthen efforts to capture maternal and newborn health policies to enable global progress assessments while reducing multiple requests to countries for similar data; 2) Monitor indicator "bundles" to understand degree of policy implementation, inconsistencies between laws and practices, and responsiveness of policies to individual and community needs; 3) Promote regular monitoring of a holistic set of human resource metrics to understand how to effectively strengthen the maternal and newborn health workforce; and 4) Develop and disseminate clear guidance for countries on how to assess health system as well as broader social and political determinants of maternal and newborn health. These lessons are consistent with the Kirkland principles of focus, relevance, innovation, equity, global leadership, and country ownership. They stress the value of indicator sets to understand complex phenomenon related to maternal and newborn health, including small groupings of complementary indicators for measuring policy implementation and health workforce issues. They also stress the fundamental ethos that maternal and newborn health indicators should only be tracked if they can drive actions at global, regional, national, or sub-national levels that improve lives. [ABSTRACT FROM AUTHOR]

Introduction: In the Global South, (in)fertility care is scarcely recognized as a priority, yet the government of The Gambia has recently included it as one of the key priorities in its reproductive health strategic plan. This inclusion appears to be the result of years of engagement between policy actors, academic researchers, and activists in the field of reproductive health and specifically of infertility. However, the operationalization of the strategic plan may be hampered by multiple factors. The research aims to identify and analyze challenges that may impede the effective implementation of the strategic plan, thereby providing policy action points and practical guidance into the operationalization of (in)fertility care in the context of The Gambia's health system., Methods: This is a mixed-methods study with data from a survey and semi-structured interviews collected between 2020 and 2021 in The Gambia that were separately published. In this paper, we present the triangulation of quantitative and qualitative data using a convergence coding matrix to identify relevant policy action points., Results: Six fertility care policy action points, driven by data, arose from the triangulation and interpretation process, specifically: (i) establishing and maintaining political commitment and national priority for fertility care; (ii) creating awareness and increasing the involvement of men in SRH and fertility; (iii) ensuring data-driven health policymaking; (iv) offering and regulating affordable IVF alternatives; (v) improving knowledge of and means for fertility care provision; and (vi) enhancing the collaboration among stakeholders and building links with the private healthcare sector., Conclusion: This study found the implementation of the fertility care-related activities in the reproductive health strategic plan may face challenges that require careful mitigation through a holistic approach. Such an approach conceptualizes infertility not just as a biomedical issue but as a broader one that incorporates educational and socio-emotional aspects, including male and (not only) female involvement in sexual and reproductive health. Moreover, it is supported by a comprehensive health management information system that includes capturing data on the demand for, and access to, infertility services in The Gambia health system., Competing Interests: AA, SD, MB, and MM declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. JB reports an honorary fellowship with MRC The Gambia Unit. AP reports paid consultancy for Cryos International, Cytoswim Ltd, Exceed Health, and Merck Serono in the last two years, but all monies have been paid to the University of Sheffield (former employer). AP is also an unpaid trustee of the Progress Educational Trust (Charity Number 1139856)., (Copyright: © 2024 Afferri et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

According to the World Health Organization (WHO), dengue is the most common acute arthropod-borne viral infection in the world. The spread of dengue and other infectious diseases is closely related to human activity and mobility. In this paper we analyze the effect of introducing mobility restrictions as a public health policy on the total number of dengue cases within a population. To perform the analysis, we use a complex metapopulation in which we implement a compartmental propagation model coupled with the mobility of individuals between the patches. This model is used to investigate the spread of dengue in the municipalities of Caldas (CO). Two scenarios corresponding to different types of mobility restrictions are applied. In the first scenario, the effect of restricting mobility is analyzed in three different ways: a) limiting the access to the endemic node but allowing the movement of its inhabitants, b) restricting the diaspora of the inhabitants of the endemic node but allowing the access of outsiders, and c) a total isolation of the inhabitants of the endemic node. In this scenario, the best simulation results are obtained when specific endemic nodes are isolated during a dengue outbreak, obtaining a reduction of up to 2.5% of dengue cases. Finally, the second scenario simulates a total isolation of the network, i.e., mobility between nodes is completely limited. We have found that this control measure increases the number of total dengue cases in the network by 2.36%. Author summary: For the World Health Organization, dengue is a disease of public health concern. In recent years there is an increasing trend in the number of dengue cases despite existing prevention and control campaigns. The mobility of the population is considered an important factor in dengue dispersion. In this paper, we are interested in addressing how restrictions to human mobility might affect the incidence of dengue in a region. Our research is relevant because the model can be adapted to other regions or scales, and the mobility control measures can be taken into account for the development of public health policies in endemic regions. [ABSTRACT FROM AUTHOR]

The validity of scientific findings may be challenged by the replicability crisis (or cases of fraud), which may result not only in a loss of trust within society but may also lead to wrong or even harmful policy or medical decisions. The question is: how reliable are scientific results that are reported as statistically significant, and how does this reliability develop over time? Based on 35,515 papers in psychology published between 1975 and 2017 containing 487,996 test values, this article empirically examines the statistical power, publication bias, and p-hacking, as well as the false discovery rate. Assuming constant true effects, the statistical power was found to be lower than the suggested 80% except for large underlying true effects (d = 0.8) and increased only slightly over time. Also, publication bias and p-hacking were found to be substantial. The share of false discoveries among all significant results was estimated at 17.7%, assuming a proportion θ = 50% of all hypotheses being true and assuming that p-hacking is the only mechanism generating a higher proportion of just significant results compared to just nonsignificant results. As the analyses rely on multiple assumptions that cannot be tested, alternative scenarios were laid out, again resulting in the rather optimistic result that although research results may suffer from low statistical power and publication selection bias, most of the results reported as statistically significant may contain substantial results, rather than statistical artifacts. [ABSTRACT FROM AUTHOR]

Background: Obesity is a global epidemic affecting all age groups, populations, and income levels across continents, though is known to disproportionately affect socioeconomically disadvantaged populations. The causes of obesity are complex, informed by diet and weight practices, but shaped by social, commercial, and environmental factors and government policy. Consequently, a Whole System Approach (WSA)–which considers the many causes of obesity and shifts the focus away from individuals as points of intervention and puts an emphasis on understanding and improving the system in which people live–is required. This scoping review of reviews aims to: determine how WSAs to diet and healthy weight have been implemented and evaluated nationally and internationally; to determine what models or theories have been used to implement WSAs; describe how WSAs have been evaluated; determine if WSAs are effective; and to identify the contribution of the public and/or service users in the development of WSAs. Method: Systematic searches were carried out using CINAHL, Scopus, PsycINFO (ProQuest), the Cochrane Library, and MEDLINE. Included review papers were those that focused on the application of a whole system approach to diet and/or healthy weight, and/or reported the theory/model used to implement or simulate this approach. Databases were searched from 1995 to March 2022 using a combination of text and Medical Subject Headings (MeSH terms). In addition, reference sections of identified articles were examined for additional relevant articles. Covidence software was used to screen titles and abstracts from the electronic databases and resolve conflicts. Results: A total of 20,308 articles were initially retrieved; after duplicate removal 7,690 unique title and abstracts were reviewed, and 110 articles were selected for full text review. On completion of full text review, 8 review articles were included for data extraction. These included: one umbrella review, four systematic reviews, a rapid review, and two literature reviews (one of which was on strategic reports written for government and public health policy). Evaluations of WSA were mainly process evaluations although health outcomes were assessed in some studies. Several conceptual frameworks or mathematical modelling approaches have been applied to WSAs for diet, healthy weight, and obesity to inform their planning or delivery, and to understand/map the associated systems. Common mathematical approaches include agent based or System Dynamic Modelling. Underlying both conceptual and mathematical models is an understanding how the elements of the complex systems impact each other to affect diet, healthy weight, and obesity. WSA implementations have reported some success in positively impacting health outcomes including reducing Body Mass Index, reducing sugary food intake, and increasing physical activity. Public and user involvement in WSA was not widely reported. Conclusion: The application of WSA to diet and healthy weight shows promise, yet the research is lagging behind their implementation. Further robust evidence for using WSA to address diet and healthy weight are required, including incorporating process and outcome evaluations (perhaps using established approaches such as Systems Dynamic Modelling). Furthermore, the analysis of epidemiological data alongside longitudinal process and outcome evaluation regarding the implementation of a WSA is required. [ABSTRACT FROM AUTHOR]

Under the influence of development strategies with regard to national fitness and health in China, the interactive development between national fitness and national health is becoming increasingly strong. To explore the coupling and coordination relationship between national fitness and national health, this paper conducts an empirical analysis of the coupling and coordination relationship between national fitness and national health in 11 provinces and cities in Eastern China using the entropy weight method, a coupling coordination model, spatial visualization of the coupling coordination degree and spatial autocorrelation analysis. The research confirms that the comprehensive development level of national fitness and national health in Eastern China shows a steady upward trend, with a lag in national fitness as a whole, and that the growth rate of national fitness development is faster than that of national health development. The coupling coordination degree of the two systems of national fitness and national health in Eastern China shows a slow upward trend, and the coupling coordination degree rises from barely coordinated to primary coordination. There are significant differences in the spatial pattern of coupling coordination: the spatial pattern from north to south generally shows 'low-high-high-low-high-low' characteristics, and the spatial spillover effect of coupling coordination in various regions has not yet appeared. The revised GM(1.1) prediction results indicate that the level and improvement rate of coupling coordination will accelerate significantly in the next 10 years, but the spatial differences will still exist. Finally, suggestions are proposed to optimize the coupling and coordinated development of national fitness and national health based on policy guarantees as well as strengthening and cross-regional cooperation. [ABSTRACT FROM AUTHOR]

Introduction: Lebanon has battled the COVID-19 pandemic in the midst of an economic crisis. The evolution of the pandemic and a fragile health system have meant that public health policy has had to rely heavily on non-pharmaceutical interventions for disease control. However, changes in disease dynamics, an unraveling economy, and pandemic fatigue have meant that disease control policies need to be updated. Methods: Using recent and timely data on older (50 years and above) Syrian refugees in Lebanon, this paper uses multivariate linear probability models to explore the determinants of adherence to two non-pharmaceutical COVID-19 prevention measures (wearing a mask and avoiding social gatherings) among this high-risk subgroup in a vulnerable population. Among respondents who report adhering to these measures, the paper also investigates the determinants of sustained adherence over a period of 6 months. Results: The findings suggest that no individual-level characteristics were robustly associated with mask wearing. For avoiding social gatherings, education was inversely associated with adherence to this preventive measure. Avoiding social gatherings was also significantly lower for residents of informal tented settlements (ITSs). Among initial adherents, and for both preventive practices, ITS dwellers were also significantly less likely to maintain adherence. Conclusion: Identifying variables associated with adherence to non-pharmaceutical preventive practices, particularly for vulnerable groups, can help inform and refine interventions in the face of changing conditions. The material, physical, administrative and socio-economic constraints of life in an ITS suggest that avoiding social gatherings is hardly feasible. Yet despite the challenging conditions of ITSs, the indication to wear a mask is initially complied with, suggesting that tailoring policies to the limits and constrains of context can lead to successful outcomes even in very adverse settings. [ABSTRACT FROM AUTHOR]

Testing remains a key tool for managing health care and making health policy during the coronavirus pandemic, and it will probably be important in future pandemics. Because of false negative and false positive tests, the observed fraction of positive tests—the surface positivity—is generally different from the fraction of infected individuals (the incidence rate of the disease). In this paper a previous method for translating surface positivity to a point estimate for incidence rate, then to an appropriate range of values for the incidence rate consistent with the model and data (the test range), and finally to the risk (the probability of including one infected individual) associated with groups of different sizes is illustrated. The method is then extended to include asymptomatic infections. To do so, the process of testing is modeled using both analysis and Monte Carlo simulation. Doing so shows that it is possible to determine point estimates for the fraction of infected and symptomatic individuals, the fraction of uninfected and symptomatic individuals, and the ratio of infected asymptomatic individuals to infected symptomatic individuals. Inclusion of symptom status generalizes the test range from an interval to a region in the plane determined by the incidence rate and the ratio of asymptomatic to symptomatic infections; likelihood methods can be used to determine the contour of the rest region. Points on this contour can be used to compute the risk (defined as the probability of including one asymptomatic infected individual) in groups of different sizes. These results have operational implications that include: positivity rate is not incidence rate; symptom status at testing can provide valuable information about asymptomatic infections; collecting information on time since putative virus exposure at testing is valuable for determining point estimates and test ranges; risk is a graded (rather than binary) function of group size; and because the information provided by testing becomes more accurate with more tests but at a decreasing rate, it is possible to over-test fixed spatial regions. The paper concludes with limitations of the method and directions for future work. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic required significant public health interventions from local governments. Although nonpharmaceutical interventions often were implemented as decision rules, few studies evaluated the robustness of those reopening plans under a wide range of uncertainties. This paper uses the Robust Decision Making approach to stress-test 78 alternative reopening strategies, using California as an example. This study uniquely considers a wide range of uncertainties and demonstrates that seemingly sensible reopening plans can lead to both unnecessary COVID-19 deaths and days of interventions. We find that plans using fixed COVID-19 case thresholds might be less effective than strategies with time-varying reopening thresholds. While we use California as an example, our results are particularly relevant for jurisdictions where vaccination roll-out has been slower. The approach used in this paper could also prove useful for other public health policy problems in which policymakers need to make robust decisions in the face of deep uncertainty. [ABSTRACT FROM AUTHOR]

The wealth-health relationship is not unambiguous and constant. Greater wealth affects individual and population health in opposite ways. Increased risk factors especially raise the probability of noncommunicable diseases (NCDs) impacting a population. Conversely, better healthcare and awareness reduce the chances of developing these diseases or increase the likelihood of treatment and cure. Therefore, this paper aims to assess and quantify the hard-to-grasp overall impact of prosperity on mortality from selected NCDs, allowing us to capture the relevant differences between European regions. In particular, we attempt to estimate the net effect of affluence and the health economic threshold of the GDP-mortality relationship, by developing a dedicated analytical tool based on joinpoint regression and forecasting methods. Our results show that in the case of most investigated diseases in more impoverished regions, a clear pattern reflects mortality rising with prosperity. After crossing the health economic threshold of around 20 thousand euros per capita, the trend changes by stabilising or reversing. The research we present shows that health policy should be more diversified locally to enable health convergence at the national and European regional levels. Moreover, health policy should evolve to prioritise mental and neurological disorders, by improving the resource allocation and increasing public awareness. [ABSTRACT FROM AUTHOR]

Background: People living with HIV (PLWH) are susceptible to social isolation as a result of stigma and discrimination, which not only diminishes adherence to antiretroviral therapy but also heightens the risks of hospital readmission, depression, and mortality. However, there is currently no systematic review addressing the occurrence and impact of social isolation in individuals with HIV. Therefore, this study undertook a comprehensive systematic review and meta-analysis of existing literature to examine the prevalence and influencing factors associated with social isolation among PLWH. Methods and analysis: PubMed, EMBASE, CINAHL, Cochrane Library, Web of Science, Google Scholar, China Science and Technology Journal Database, The China National Knowledge Infrastructure, WanFang Data and Chinese Biomedicine Literature Database will be searched from the establishment of the database to the latest search date. Literature screening, data extraction and literature quality assessment will be done independently by two researchers and results will be cross-referenced. Data analysis will be performed using stata15.1 software. Risk of publication bias will be assessed using Begg's and Egger's methods. Heterogeneity between studies will then be assessed using the I2 index and its 95% CI and Q statistics. Sources of heterogeneity will be accounted for by subgroup and sensitivity analyses. Results: The results may reveal the prevalence of social isolation among PLWH and provide data support for understanding its etiology and prevention. Conclusion: By systematically reviewing the existing literature on social isolation among PLWH, this study aims to provide a comprehensive understanding of the prevalence of social isolation within this population, elucidate the detrimental effects it poses for people affected by HIV, and effectively inform targeted interventions for high-risk groups. Furthermore, these findings offer valuable insights to support evidence-based decision-making in public health policy. Systematic review registration: PROSPERO registration number: CRD42024499044 [ABSTRACT FROM AUTHOR]

Understanding the global burden of enterotoxigenic E. coli (ETEC) and Shigella diarrhea as well as estimating the cost effectiveness of vaccines to control these two significant pathogens have been hindered by the lack of a diagnostic test that is rapid, simple, sensitive, and can be applied to the endemic countries. We previously developed a simple and rapid assay, Rapid Loop mediated isothermal amplification based Diagnostic Test (RLDT) for the detection of ETEC and Shigella spp. (Shigella). In this study, the RLDT assay was evaluated in comparison with quantitative PCR (qPCR), culture and conventional PCR for the detection of ETEC and Shigella. This validation was performed using previously collected stool samples from endemic countries, from the travelers to the endemic countries, as well as samples from a controlled human infection model study of ETEC. The performance of RLDT from dried stool spots was also validated. RLDT resulted in excellent sensitivity and specificity compared to qPCR (99% and 99.2% respectively) ranging from 92.3 to 100% for the individual toxin genes of ETEC and 100% for Shigella. Culture was less sensitive compared to RLDT. No significant differences were noted in the performance of RLDT using samples from various sources or stool samples from moderate to severe diarrhea or asymptomatic infections. RLDT performed equally well in detection of ETEC and Shigella from the dried stool samples on filter papers. This study established that RLDT is sufficiently sensitive and specific to be used as a simple and rapid diagnostic assay to detect ETEC and Shigella in endemic countries to determine disease burden of these pathogens in the national and subnational levels. This information will be important to guide public health and policy makers to prioritize resources for accelerating the development and introduction of effective preventative and/or treatment interventions against these enteric infections. Author summary: Enterotoxigenic E. coli (ETEC) and Shigella spp (Shigella) causes significant global morbidity and mortality, especially in low-and middle-income countries (LMICs). Since culture methods to detect Shigella are not sensitive, and the methods used to detect ETEC have not been feasible outside of specialized, well-equipped laboratories, the true burden of these pathogens at national and sub-national levels are mostly not available. Morbidity and mortality estimates, for these two pathogens are crucial to assess their relative public health importance in LMICs. We developed a simple and rapid diagnostic assay called the RLDT (Rapid Loop-mediated isothermal amplification based Diagnostic Test) for detection of ETEC and Shigella. In this study we evaluated RLDT compared to other currently available assays using previously collected stool samples. Our data showed that the RLDT assay exhibited high sensitivity and specificity for detection of ETEC and Shigella, with its result available within 50 minutes. The sensitivity of RLDT was higher than culture for these pathogens. We conclude that RLDT could be used as a rapid and simple diagnostic test to determine the burden of ETEC and Shigella in LMICs as well as in clinical vaccine trials of these pathogens. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, concerns emerged that vaccinated individuals might engage less in infection-preventive behaviors, potentially contributing to virus transmission. This study evaluates the causal effects of COVID-19 vaccination on such behaviors within Japan, highlighting the significance of understanding behavioral dynamics in public health strategies. Methods: Utilizing Japan's age-based vaccination priority for those born before April 1, 1957, this research employs a regression discontinuity design (RDD) to assess the vaccination's impact. Data from the fourth round of a longitudinal online survey, conducted from July 20 to 27, 2021, served as the basis for analyzing 14 infection-protective behaviors, including mask usage, handwashing, and avoiding crowds. Results: A total of 12067 participants completed the survey. The analyzed sample size varied by outcome variable, ranging from 1499 to 5233. The analysis revealed no significant differences in the 14 behaviors examined among fully vaccinated, partially vaccinated, and unvaccinated individuals. This consistency across groups suggests that vaccination status did not significantly alter engagement in protective behaviors during the observation period. Conclusions: Empirical findings highlight the complexity of behavioral responses following vaccination, indicating that such responses may be influenced by various factors, rather than by vaccination status alone. Additionally, this result underscores the importance of crafting public health policies that account for the intricate interplay between vaccination and behavior. This study contributes to the broader discourse on managing responses to the pandemic and tailoring interventions to sustain or enhance protective health behaviors amid vaccination rollouts. [ABSTRACT FROM AUTHOR]

In recent decades, policy initiatives involving increases in the tobacco tax have increased pressure on budget allocations in poor households. In this study, we examine this issue in the context of the expansion of the social welfare state that has taken place over the last two decades in several emerging economies. This study explores the case of Colombia between 1997 and 2011. In this period, the budget share of the poorest expenditure quintile devoted to tobacco products of smokers' households doubled. We analyse the differences between the poorest and richest quintiles concerning the changes in budget shares, fixing a reference population over time to avoid demographic composition confounders. We find no evidence of crowding-out of education or healthcare expenditures. This is likely to be the result of free universal access to health insurance and basic education for the poor. For higher-income households, tobacco crowds out expenditures on entertainment, leisure activities, and luxury expenditures. This finding should reassure policymakers who are keen to impose tobacco taxes as an element of their public health policy. [ABSTRACT FROM AUTHOR]

Ambulance services around the world vary according to regional, cultural and socioeconomic conditions. Many countries apply different health policies locally. In Turkey, transportation from hospital to home has started to form an important part of ambulance services in recent years. The increase in the number of patients whose treatment has been completed and waiting to be referred may hinder the work of the emergency services. The aim of this study was to examine the costs, indications, and impact on workload of patients sent home by ambulance. Patients were divided into two groups according to the reasons for referral. The distance to home, transport time and cost were calculated according to the reasons for transport. Patients who were transferred to other clinics or hospitals by ambulance were excluded from the study. The findings showed that the hospital-to-home transfer rate during the study period was 11.4%. Although 9.7% of all cases transferred from our hospital to home were due to social indications, these cases accounted for 16.26% of the total costs. These results suggest that providing home transport services to selected patient groups for medical reasons should be seen as part of the treatment. However, the indications for home transport should not be exceeded and an additional burden should not be placed on the fragile health service. [ABSTRACT FROM AUTHOR]

Introduction: Despite the burden of cardiovascular disease (CVD) continuing to increase globally, no comprehensive meta-analyses have been conducted quantifying premature CVD mortality. This paper reports the protocol for a systematic review and meta-analysis to derive updated estimates of premature CVD mortality. Methods and expected outputs: This review will include the studies that reported premature CVD mortality based on standard premature mortality indicators, including years of life lost (YLL), age standardized mortality rate (ASMR) or standardised mortality ratio (SMR). PUBMED, Scopus, Web of Science (WoS), CINAHL, and Cochrane Central Register of Controlled Trials (CENTRAL) will be used as the literature databases. The study selection as well as the evaluation of the quality of the included articles will be done independently by two reviewers. Pooled estimates of YLL, ASMR, and SMR will be computed by applying random-effects meta-analysis. Heterogeneity among selected studies will be assessed using the I2 statistic and Q statistic with associated p-values. A funnel plot analysis and Egger's test will be conducted to assess the potential impact of publication bias. Depending on data availability, we propose to conduct subgroup analyses by sex, geographic location, main CVD types, and study time. Reporting of our findings will follow the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Conclusion: Our meta-analysis will provide a comprehensive synthesis of the available evidence on premature CVD mortality, which is a major public health concern worldwide. The results of this meta-analysis will have important implications for clinical practice and public health policy, providing insights into strategies to prevent and manage premature CVD mortality. Trial registration: Systematic review registration: PROSPERO CRD42021288415. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021288415. [ABSTRACT FROM AUTHOR]

Climate change is an ongoing topic in nearly all areas of society since many years. A discussion of climate change without referring to scientific results is not imaginable. This is especially the case for policies since action on the macro scale is required to avoid costly consequences for society. In this study, we deal with the question of how research on climate change and policy are connected. In 2019, the new Overton database of policy documents was released including links to research papers that are cited by policy documents. The use of results and recommendations from research on climate change might be reflected in citations of scientific papers in policy documents. Although we suspect a lot of uncertainty related to the coverage of policy documents in Overton, there seems to be an impact of international climate policy cycles on policy document publication. We observe local peaks in climate policy documents around major decisions in international climate diplomacy. Our results point out that IGOs and think tanks-with a focus on climate change-have published more climate change policy documents than expected. We found that climate change papers that are cited in climate change policy documents received significantly more citations on average than climate change papers that are not cited in these documents. Both areas of society (science and policy) focus on similar climate change research fields: biology, earth sciences, engineering, and disease sciences. Based on these and other empirical results in this study, we propose a simple model of policy impact considering a chain of different document types: The chain starts with scientific assessment reports (systematic reviews) that lead via science communication documents (policy briefs, policy reports or plain language summaries) and government reports to legislative documents., Competing Interests: The authors have declared that no competing interests exist.

The COVID-19 epidemic is the most significant global health disaster of this century and the greatest challenge to humanity since World War II. One of the most important research issues is to determine the effectiveness of measures implemented worldwide to control the spread of the corona virus. A dynamic simulated Autoregressive-Distributed Lag (ARDL) approach was adopted to analyze the policy response to COVID-19 in the ASEAN region using data from February 1, 2020, to November 8, 2021. The results of unit root concluded that the dependent variable is integrated of order one while the independent variables are stationarized at the level or first difference, and the use of a dynamic simulated ARDL technique is appropriate for this paper. The outcomes of the dynamic simulated ARDL model explored that government economic support and debt/contract relief for poor families is substantially important in the fight against COVID-19. The study also explored that closing schools and workplaces, restrictions on gatherings, cancellation of public events, stay at home, closing public transport, restrictions on domestic and international travel are necessary to reduce the spread of COVID-19. Finally, this study explored that public awareness campaigns, testing policy and social distancing significantly decrease the spread of COVID-19. Policy implications such as economic support from the government to help poor families, closing schools and public gatherings during the pandemic, public awareness among the masses, and testing policies must be adopted to reduce the spread of COVID-19. Moreover, the reduction in mortality shows that immunization could be a possible new strategy to combat COVID-19, but the factors responsible for the acceptability of the vaccine must be addressed immediately through public health policies. [ABSTRACT FROM AUTHOR]

Background: Climate Change (CC) emanating from anthropocentric human activities is a great threat to the quality of human life and well-being worldwide. The translation of CC research evidence can play a critical role in promoting the formulation of climate-sensitive policies to equip public health systems for CC-associated disaster preparedness, response, and management. This scoping review seeks to explore knowledge translation approaches for promoting, the uptake, and use of CC research evidence in public health policy and practice. Methods: This scoping review will be conducted according to the guidelines of Arksey and O'Malley. A search strategy will be developed for published articles in PubMed, CINAHL, and Scopus databases and for grey literature in the World Health Organization, Planetary Health Alliance, and the University of the Western Cape repositories. Discussion: The proposed scoping review will gather existing evidence on the relationship between knowledge translation, CC research, and public health decision-making. This will provide insights into research and practice gaps, and recommendations will be made to ensure effective knowledge translation for CC related decision-making. [ABSTRACT FROM AUTHOR]

Background: Adults living alone represent a growing population group in China. Understanding the prevalence of body mass index (BMI) categories and their associations with demographic and lifestyle factors among this group is essential for informing targeted interventions and public health policies. Methods: In this population-based cross-sectional study, we used individual-level data from the 2011–2021 China General Social Survey. Main outcomes were prevalence of BMI categories adjusted for gender and age, using logistic regression and model-predicted marginal prevalence to estimate BMI categories prevalence. Results: We analyzed 9,077 single-living Chinese adult participants. The primary-adjusted prevalence of BMI categories varied across different genders and age groups. Underweight was more prevalent in females (12.73%; 95% CI: 12.31% - 13.14%) than in males (7.54%; 95% CI: 7.19% - 7.88%), while overweight and obesity were higher in males. Primary-adjusted underweight prevalence was highest among the 18–24 years age group (22.09%; 95% CI: 20.17% - 24.01%) and decreased with age. Primary-adjusted overweight prevalence increased with age, peaking in the 45–54 years age group (41.94%; 95% CI: 40.96% - 42.93%). Primary-adjusted obesity prevalence exhibited a fluctuating pattern across age groups, with the highest prevalence observed in the 45–54 years age group (9.81%; 95% CI: 9.19% - 10.44%). Conclusion: Our findings reveal significant associations between BMI categories and demographic and lifestyle factors among adults living alone in China. These results can inform targeted interventions and public health policies aimed at promoting healthy weight management and addressing the unique health challenges faced by single-living individuals in China. [ABSTRACT FROM AUTHOR]

Socioeconomic factors have exacerbated the impact of COVID–19 worldwide. Brazil, already marked by significant economic inequalities, is one of the most affected countries, with one of the highest mortality rates. Understanding how inequality and income segregation contribute to excess mortality by COVID–19 in Brazilian cities is essential for designing public health policies to mitigate the impact of the disease. This paper aims to fill in this gap by analyzing the effect of income inequality and income segregation on COVID–19 mortality in large urban centers in Brazil. We compiled weekly COVID–19 mortality rates from March 2020 to February 2021 in a longitudinal ecological design, aggregating data at the city level for 152 Brazilian cities. Mortality rates from COVID-19 were compared across weeks, cities and states using mixed linear models. We estimated the associations between COVID-19 mortality rates with income inequality and income segregation using mixed negative binomial models including city and week-level random intercepts. We measured income inequality using the Gini index and income segregation using the dissimilarity index using data from the 2010 Brazilian demographic census. We found that 88.2% of COVID–19 mortality rates variability was between weeks, 8.5% between cities, and 3.3% between states. Higher-income inequality and higher-income segregation values were associated with higher COVID–19 mortality rates before and after accounting for all adjustment factors. In our main adjusted model, rate ratios (RR) per 1 SD increases in income inequality and income segregation were associated with 17% (95% CI 9% to 26%) and 11% (95% CI 4% to 19%) higher mortality. Income inequality and income segregation are long-standing hallmarks of large Brazilian cities. Risk factors related to the socioeconomic context affected the course of the pandemic in the country and contributed to high mortality rates. Pre-existing social vulnerabilities were critical factors in the aggravation of COVID–19, as supported by the observed associations in this study. [ABSTRACT FROM AUTHOR]

In the aftermath of shock events, policy responses tend to be crafted under significant time constraints and high levels of uncertainty. The extent to which individuals comply with different policy designs can further influence how effective the policy responses are and how equitably their impacts are distributed in the population. Tools which allow policymakers to model different crisis trajectories, policy responses, and behavioral scenarios ex ante can provide crucial timely support in the decision-making process. Set in the context of COVID-19 shelter in place policies, in this paper we present the COVID-19 Policy Evaluation (CoPE) tool, which is an agent-based modeling framework that enables researchers and policymakers to anticipate the relative impacts of policy decisions. Specifically, this framework illuminates the extent to which policy design features and behavioral responsiveness influence the efficacy and equity of policy responses to shock events. We show that while an early policy response can be highly effective, the impact of the timing is moderated by other aspects of policy design such as duration and targeting of the policy, as well as societal aspects such as trust and compliance among the population. More importantly, we show that even policies that are more effective overall can have disproportionate impacts on vulnerable populations. By disaggregating the impact of different policy design elements on different population groups, we provide an additional tool for policymakers to use in the design of targeted strategies for disproportionately affected populations., Competing Interests: The authors have declared that no competing interests exist.

Background: Ethiopia has low malaria prevalence compared to most other malaria-endemic countries in Africa. However, malaria is still a major public health problem in the country. The binary logistic regression model has been widely used to analyse malaria indicator survey (MIS) data. However, most MIS have a hierarchical structure which may result in dependent data. Since this model assumes that conditional on the covariates the malaria statuses of individuals are independent, it ignores potential intra-cluster correlation among observations within a cluster and may generate biased analysis results and conclusions. Therefore, the aim of this study was to quantify the variation in the prevalence of malaria between sample enumeration areas (SEAs) or clusters, the effects of cluster characteristics on the prevalence of malaria using the intra-class correlation coefficient as well as to identify significant factors that affect the prevalence of malaria using the multilevel logistic regression modelling in three major regions of Ethiopia, namely Amhara, Oromia and Southern Nations, Nationalities and Peoples' (SNNP). Methods: Dataset for three regional states extracted from the 2011 Ethiopian National Malaria Indicator Surveys (EMIS) national representative samples was used in this study. It contains 9272 sample individuals selected from these regions. Various multilevel models with random sample SEA effects were applied taking into account the survey design weights. These weights are scaled to address unequal probabilities of selection within clusters. The spatial clustering of malaria prevalence was assessed applying Getis-Ord statistic to best linear unbiased prediction values of model random effects. Results: About 53.82 and 28.72 per cents of the sampled households in the study regions had no mosquito net and sprayed at least once within the last 12 months, respectively. The results of this study indicate that age, gender, household had mosquito nets, the dwelling has windows, source of drinking water, the two SEA-level variables, i.e. region and median altitude, were significantly related to the prevalence of malaria. After adjusting for these seven variables, about 45% of the residual variation in the prevalence of malaria in the study regions was due to systematic differences between SEAs, while the remaining 55% was due to unmeasured differences between persons or households. The estimated MOR, i.e. the unexplained SEA heterogeneity, was 4.784. This result suggests that there is high variation between SEAs in the prevalence of malaria. In addition, the 80% interval odds ratios (IORs) related to SEA-level variables contain one suggesting that the SEA variability is large in comparison with the effect of each of the variable. Conclusions: The multilevel logistic regression with random effects model used in this paper identified five individual / household and two SEA-level risk factors of malaria infection. Therefore, the public health policy makers should pay attentions to those significant factors, such as improving the availability of pure drinking water. Further, the findings of spatial clustering provide information to health policymakers to plan geographically targeted interventions to control malaria transmission. [ABSTRACT FROM AUTHOR]

Background: Industry self-regulation is the dominant approach to managing alcohol advertising in Australia and many other countries. There is a need to explore the barriers to government adoption of more effective regulatory approaches. This study examined relevance and quality features of evidence cited by industry and non-industry actors in their submissions to Australian alcohol advertising policy consultations., Methods: Submissions to two public consultations with a primary focus on alcohol advertising policy were analysed. Submissions (n = 71) were classified into their actor type (industry or non-industry) and according to their expressed support for, or opposition to, increased regulation of alcohol advertising. Details of cited evidence were extracted and coded against a framework adapted from previous research (primary codes: subject matter relevance, type of publication, time since publication, and independence from industry). Evidence was also classified as featuring indicators of higher quality if it was either published in a peer-reviewed journal or academic source, published within 10 years of the consultation, and/or had no apparent industry connection., Results: Almost two-thirds of submissions were from industry actors (n = 45 submissions from alcohol, advertising, or sporting industries). With few exceptions, industry actor submissions opposed increased regulation of alcohol advertising and non-industry actor submissions supported increased regulation. Industry actors cited substantially less evidence than non-industry actors, both per submission and in total. Only 27% of evidence cited by industry actors was highly relevant and featured at least two indicators of higher quality compared to 58% of evidence cited by non-industry actors., Conclusions: Evaluation of the value of the evidentiary contribution of industry actors to consultations on alcohol advertising policy appears to be limited. Modifications to consultation processes, such as exclusion of industry actors, quality requirements for submitted evidence, minimum standards for referencing evidence, and requirements to declare potential conflicts, may improve the public health outcomes of policy consultations., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: JS and HP contributed to the written submission of the McCusker Centre for Action on Alcohol and Youth to the inquiry into the NSW Alcoholic Beverages Advertising Prohibition Bill 2015 and JS appeared as a witness to a public hearing held for the inquiry. JS and HP contributed to the written submission of the McCusker Centre for Action on Alcohol and Youth to the ANPHA issues paper. TC was a member of the Australian National Preventive Health Agency’s expert committee on alcohol and contributed to drafting of the final report.

One strategy for the prevention and treatment of non-communicable diseases (NCDs) is the implementation of the front-of-pack labeling (FoPL) in foods and beverages. In 2020, Mexico adopted the warning label system (WL) as a new public health policy, whose aim is to help consumers make healthier food choices. Previously, the Guideline Daily Amount (GDA) was the labelling used it. This paper aims to compare the understanding of two FoPL, the GDA and the WL, through the identification of unhealthy products in Mexicans with NCDs. We analyzed data from 14,880 Mexican adults older than 20 years old with NCDs (overweight-obesity (OW/O), self-reported diabetes mellitus 2 (DM2), or/and hypertension (HT), or/and dyslipidemia (Dys)). Participants were randomly assigned to one of two groups: the GDA labeling or WL. Each group had to respond to a survey and had to classify food products images as healthy or unhealthy according to the labelling system to which they were assigned. The correct classification was determined according to the criteria of Chile's labeling nutrient profile stage 3. To evaluate the correct classification in each one of the groups we evaluated the differences in proportions. Logistic regression models were used to assess the likelihood to correctly classify the product according to participants' number of diseases and WL information, taking GDA label as a reference. Participants who used the information contained in the GDA label misclassified food product labels in greater proportion (70%), mostly participants with three or more NCDs (participants with OW/O+ HT+ Dys, represent 42.3% of this group); compared with those who used WL (50%). The odds of correct classification of food products using WL image were two times greater compared to GDA image in participants with NCDs; being greater in participants with three or more NCDs. The study results highlight the usefulness of WL as it helps Mexicans with NCDs to classify unhealthy food products more adequately compared with GDA. [ABSTRACT FROM AUTHOR]

Background: Dengue (DENV), Ross River (RRV) and Barmah Forest viruses (BFV) are the most common human arboviral infections in Australia and the Pacific Island Countries and Territories (PICTs) and are associated with debilitating symptoms. All are nationally notifiable in Australia, but routine surveillance is limited to a few locations in the PICTs. Understanding the level of human exposure to these viruses can inform disease management and mitigation strategies. To assess the historic and current seroprevalence of DENV, RRV and BFV in Australia and the PICTs we conducted a systematic literature review of all published quantitative serosurveys. Methodology and principal findings: The Preferred Reporting of Items for Systematic Reviews and Meta-Analyses procedures were adopted to produce a protocol to systematically search for published studies reporting the seroprevalence of DENV, RRV and BFV in Australia and the PICTs. Data for author, research year, location, study population, serosurvey methods and positive tests were extracted. A total of 41 papers, reporting 78 serosurveys of DENV, RRV and BFV including 62,327 samples met the inclusion criteria for this review. Seroprevalence varied depending on the assay used, strategy of sample collection and location of the study population. Significant differences were observed in reported seropositivity depending on the sample collection strategy with clinically targeted sampling reporting the highest seroprevalence across all three viruses. Non-stratified seroprevalence showed wide ranges in reported positivity with DENV 0.0% -95.6%, RRV 0.0%-100.0%, and BFV 0.3% to 12.5%. We discuss some of the causes of variation including serological methods used, selection bias in sample collection including clinical or environmental associations, and location of study site. We consider the extent to which serosurveys reflect the epidemiology of the viruses and provide broad recommendations regarding the conduct and reporting of arbovirus serosurveys. Conclusions and significance: Human serosurveys provide important information on the extent of human exposure to arboviruses across: (1) time, (2) place, and (3) person (e.g., age, gender, clinical presentation etc). Interpreting results obtained at these scales has the potential to inform us about transmission cycles, improve diagnostic surveillance, and mitigate future outbreaks. Future research should streamline methods and reduce bias to allow a better understanding of the burden of these diseases and the factors associated with seroprevalence. Greater consideration should be given to the interpretation of seroprevalence in studies, and increased rigour applied in linking seroprevalence to transmission dynamics. Author summary: Mosquito-borne viruses contribute significantly to the global burden of diseases. Understanding infection rates in human populations is important for informing management of disease burden and public health policy. Serosurveys measure population exposure and immunity after arbovirus infections. We systematically reviewed serosurveys conducted for dengue virus (DENV), Ross River virus (RRV), and Barmah Forest virus (BFV) in Australia and the PICTs. We identified 41 studies reporting 78 serosurveys published between 1966 and 2020. For DENV we found the highest seroprevalence, greater than 95.0%, was reported in American Samoa. For RRV we found early evidence (1960–1969) of circulation outside Australia. There were three studies of BFV reporting 16 serosurveys within Australia and reporting low seroprevalence (<13%). Researchers used different serological methods so study comparisons must be nuanced. [ABSTRACT FROM AUTHOR]

Due to increasing demand and scarce financial resources for healthcare, health system efficiency has become a major topic in political and scientific debates. While previous studies investigating determinants of health system efficiency focused primarily on economic and social influence factors, the role of the political regime has been neglected. In addition, there is a lack of formal theoretical work on this specific topic, which ensures transparency and logical consistency of arguments and implications. Using a public choice approach, this paper provides a rigorous theoretical and empirical investigation of the relationships between health system efficiency and political institutions. We develop a simple principal-agent model describing the behavior of a government with respect to investments in population health under different political regimes. The main implication of the theoretical model is that governments under more democratic regimes put more effort in reducing embezzlement of health expenditure than non-democratic regimes. Accordingly, democratic countries are predicted to have more efficient health systems than non-democratic countries. We test this hypothesis based on a broad dataset including 158 countries over the period 1995-2015. The empirical results clearly support the implications of the theoretical model and withstand several robustness checks, including the use of alternative indicators for population health and democracy and estimations accounting for endogeneity. The empirical results also indicate that the effect of democracy on health system efficiency is more pronounced in countries with higher income levels. From a policy perspective, we discuss the implications of our findings in the context of health development assistance., Competing Interests: The authors have declared that no competing interests exist.

Context: There is compelling evidence that eliminating sexually transmitted infections (STIs) among female sex workers (FSWs) is a cost-effective approach to reducing the spread of HIV/AIDS. Although many countries recognise sex work as a public health issue, few have implemented public health policies specifically aimed at controlling the transmission of HIV/AIDS among FSWs. In particular, Senegal stands out as the only African country to regulate sex work through a specific public health policy that requires FSWs to register with a health centre. Despite the potential health and legal benefits associated with registration, a staggering 80% of FSWs in Senegal remain unregistered. This low registration rate hinders the realisation of the policy's full potential for public health benefits. The reluctance of FSWs to register is due to inherent flaws in the policy design, where the disadvantages of registration outweigh the benefits for FSWs. Objective: To identify which modifications to the current registration policy have the potential to increase uptake of registration by FSWs and to assess their feasibility in the context of Senegal. Method: We conducted a qualitative policy research study using semi-structured in-depth interviews with 22 national stakeholders in this policy, including representatives from the police, government and non-governmental organisations (NGOs) in Dakar, Senegal, as well as FSWs' leaders. The interview data were thematically coded using the interview topic guide and other recurring themes and analysed using thematic analysis on Nvivo 12. Results: A total of 20 relevant themes were selected, focusing primarily on assessing the feasibility of potential interventions and identifying potential barriers and associated risks. We found that, without changing current legislation, improving relationships between FSWs and police officers, providing accurate and accessible information about the rules and benefits of the policy, and offering psychosocial support have the potential to improve both the registration rate of FSWs and their wellbeing. Policy features designed to increase registration by improving FSWs' confidentiality, and thus their confidence in the services offered, were also discussed. Conclusions: The study highlighted that several national public health policies could be changed to increase the registration rate of FSWs and improve their wellbeing without overturning constitutional law. [ABSTRACT FROM AUTHOR]

There have been repeated calls for academic institutions to develop policies and procedures to manage institutional conflicts of interest (ICOI) arising from technology transfer activities. While prior research has examined adoption of ICOI policies by medical schools and universities, little is known about how these institutions handle ICOI in practice, hindering the development of evidence-based recommendations to improve ICOI management. To address this gap, we conducted semi-structured interviews with 25 senior administrators responsible for research integrity and conflict of interest issues at academic institutions. Data were analyzed using a descriptive qualitative content analysis approach, combining flexible coding to index the interview data with close examination, interpretation, and synthesis of coded content. Participants identified communication and information sharing between conflict of interest (COI) and technology transfer (TT) offices as a critical factor in the effective management of ICOI and suggested several strategies to strengthen coordination between these offices. These findings suggest that academic research institutions could strengthen COI programs by taking measures to improve communication and information sharing between COI and TT offices. [ABSTRACT FROM AUTHOR]

Background: Snake bites cause considerable morbidity and mortality worldwide, yet evidence from low- and middle-income countries remains fragmented. This is particularly the case in Eastern Mediterranean Region where available data on snake bites is relatively weak. Without reliable data, it is difficult to make the case for greater visibility and investment to address the snakebite burden in this Region. A scoping review was therefore conducted to summarize evidence on snake bites in countries of the Eastern Mediterranean. Methodology/principal findings: The review employed manual and electronic searching methods of four databases plus Google Scholar, ultimately including 196 records from 20 countries published between 2000 and 2023. More than half originated from Iran, Morocco, and Pakistan. Many records lacked information on permanent sequalae, disability, snake species, and types and sources of antivenoms. When identified, offending snakes belonged to 30 species. Use of more than 12 types of antivenoms were described across the Region, and some were not specific to indigenous species. Conclusion/significance: Despite the relatively large number of publications identified, the data were concentrated in just a few countries in the Region, and there was little or no information available for the remainder. As is the case worldwide, disability associated with snake bites was poorly characterized and quantified across the Region. There is an urgent need for concrete action at national and regional levels to enhance epidemiological surveillance, research, and the collection of clinical, disability and outcomes data to inform policy and public health investment. Greater regional cooperation and collaboration is also crucial for addressing this neglected disease throughout the Region. Author summary: Snake bites are a particular public health concern worldwide. Compared to other parts of the world, the available data on snake bites in the Eastern Mediterranean Region–a region spanning large parts of North Africa and the Middle East all the way to Pakistan and Afghanistan–is relatively weak. Without reliable data it is difficult to make the case for greater visibility and investments to address snakebite burden in the Region. To address this knowledge gap, we conducted the first scoping review to summarize evidence on snake bites from all 22 countries of the Eastern Mediterranean. Despite identifying 196 publications, we found that evidence was concentrated in a few countries and remained limited or absent for most of the Region. Moreover, a significant proportion of publications lacked information on long-term health consequences, snake species involved, and types and sources of antivenoms used. Our review highlights the need to improve data collection on snakebite burden as part of routine health information systems and community-based surveillance, and to address disability in future research. Additionally, findings suggest that some countries need to review their procurement practices of antivenoms to ensure availability and use of appropriate quality products in the future. [ABSTRACT FROM AUTHOR]

During an infectious disease outbreak, public health policy makers are tasked with strategically implementing interventions whilst balancing competing objectives. To provide a quantitative framework that can be used to guide these decisions, it is helpful to devise a clear and specific objective function that can be evaluated to determine the optimal outbreak response. In this study, we have developed a mathematical modelling framework representing outbreaks of a novel emerging pathogen for which non-pharmaceutical interventions (NPIs) are imposed or removed based on thresholds for hospital occupancy. These thresholds are set at different levels to define four unique strategies for disease control. We illustrate that the optimal intervention strategy is contingent on the choice of objective function. Specifically, the optimal strategy depends on the extent to which policy makers prioritise reducing health costs due to infection over the costs associated with maintaining interventions. Motivated by the scenario early in the COVID-19 pandemic, we incorporate the development of a vaccine into our modelling framework and demonstrate that a policy maker's belief about when a vaccine will become available in future, and its eventual coverage (and/or effectiveness), affects the optimal strategy to adopt early in the outbreak. Furthermore, we show how uncertainty in these quantities can be accounted for when deciding which interventions to introduce. This research highlights the benefits of policy makers being explicit about the precise objectives of introducing interventions. Author summary: While often necessary to contain an infectious disease outbreak, extensive interventions result in education, economic and societal harms. For the optimal response to be determined, the trade-off between the costs and benefits of disease control requires policy makers to define and communicate their objectives for managing the outbreak. We use a mathematical model to simulate outbreaks where social distancing is implemented when disease prevalence within hospital settings is high. We consider four distinct strategies for managing the outbreak based on different hospital prevalence thresholds for switching between levels of social distancing. The optimal strategy to implement depends on how a policy maker balances the importance of reducing the number of hospitalisations and the costs of maintaining interventions. The optimal strategy to implement at the beginning of the outbreak is further impacted by beliefs regarding the future availability of a vaccine. We develop a quantitative decision making framework which explicitly considers the objectives of policy makers and allows robust strategies for future disease outbreaks to be designed. [ABSTRACT FROM AUTHOR]

The combined region of eastern Tennessee and western North Carolina has a persistently high risk of pediatric La Crosse virus neuroinvasive disease (LACV-ND). To guide public health intervention in this region, the objectives of this retrospective ecological study were to investigate the geographic clustering and predictors of pediatric LACV-ND risk at the ZIP code tabulation area (ZCTA) level. Data on pediatric cases of LACV-ND reported between 2003 and 2020 were obtained from Tennessee Department of Health and North Carolina Department of Health and Human Services. Purely spatial and space-time scan statistics were used to identify ZCTA-level clusters of confirmed and probable pediatric LACV-ND cases from 2003–2020, and a combination of global and local (i.e., geographically weighted) negative binomial regression models were used to investigate potential predictors of disease risk from 2015–2020. The cluster investigation revealed spatially persistent high-risk and low-risk clusters of LACV-ND, with most cases consistently reported from a few high-risk clusters throughout the entire study period. Temperature and precipitation had positive but antagonistic associations with disease risk from 2015–2020, but the strength of those relationships varied substantially across the study area. Because LACV-ND risk clustering in this region is focally persistent, retroactive case surveillance can be used to guide the implementation of targeted public health intervention to reduce the disease burden in high-risk areas. Additional research on the role of climate in LACV transmission is warranted to support the development of predictive transmission models to guide proactive public health interventions. Author summary: La Crosse virus (LACV) is the most common cause of mosquito-borne neuroinvasive disease (e.g., encephalitis or meningitis) among children in the United States, but the spatial patterns and population-level risk factors for LACV infections are not well understood. In this study, we investigated the spatial patterns and areal risk factors of pediatric LACV neuroinvasive disease (LACV-ND) in eastern Tennessee and western North Carolina, a persistent hotspot of LACV-ND. We found that from 2003–2020, the highest risks of pediatric LACV-ND consistently occurred in a few areas within the study region. We also found that precipitation and temperature had positive but antagonistic relationships with area-level risk from 2015–2020, although the strength of those associations varied significantly across the study area. The results of this study have important implications for public health policy. Most notably, because LACV-ND consistently occurs in the same geographic areas over extended time periods, areas where cases have been previously reported should be prioritized for disease prevention programs to prevent continuous transmission. This study also provides initial evidence that climate may be related to the distribution of LACV-ND risk, but additional research is needed to better understand the complex relationship between climate and LACV epidemiology. [ABSTRACT FROM AUTHOR]

Introduction: The increased prevalence of visual impairment among diabetes patients has become a major global public health problem. Although numerous primary studies have been conducted to determine the prevalence of visual impairment and its associated factors among diabetes patients in Ethiopia, these studies presented inconsistent findings. Therefore, this review aimed to determine the pooled prevalence of visual impairment and identify associated factors among diabetes patients. Methods: An extensive search of literature was done on PubMed, Google Scholar, and Web of Sciences databases. A manual search of the reference lists of included studies was performed. A weighted inverse-variance random-effects model was used to calculate the pooled prevalence of visual impairment. Results: A total of 34 eligible primary studies with a sample size of 11,884 participants were included in the final meta-analysis. The pooled prevalence of visual impairment was 21.73% (95% CI: 18.15, 25.30; I2 = 96.47%; P<0.001). Diabetes mellitus with a duration of diagnosis ≥10 years [AOR = 3.18, 95% CI: 1.85, 5.49], presence of co-morbid hypertension [AOR = 3.26, 95% CI: 1.93, 5.50], poor glycemic control [AOR = 4.30, 95% CI: 3.04, 6.06], age ≥56 years [AOR = 4.13, 95% CI: 2.27, 7.52], family history of diabetes mellitus [AOR = 4.18 (95% CI: 2.61, 6.69], obesity [AOR = 4.77, 95% CI: 3.00, 7.59], poor physical activity [AOR = 2.46, 95% CI: 1.75, 3.46], presence of visual symptoms [AOR = 4.28, 95% CI: 2.73, 6.69] and no history of eye exam [AOR = 2.30, 95% CI: 1.47, 3.57] were significantly associated with visual impairment. Conclusions: The pooled prevalence of visual impairment was high in Ethiopia. Diabetes mellitus with a duration of diagnosis ≥10 years, presence of co-morbid hypertension, poor glycemic control, age ≥56 years, and family history of diabetes mellitus, obesity, poor physical activity, presence of visual symptoms, and no history of eye exam were independent predictors. Therefore, diabetic patients with these identified risks should be screened, and managed early to reduce the occurrence of visual impairment related to diabetes. Moreover, public health policy with educational programs and regular promotion of sight screening for all diabetes patients are needed. [ABSTRACT FROM AUTHOR]

Background: The government of the Republic of Moldova, endorsed the principle of Health in All Policies (HiAP) through its health sector reforms to address the rising burden of non-communicable diseases and health inequalities. Territorial Public Health Councils (TPHCs) were created to ensure the coordination and management of the population's health in their respective district. This study assessed the capacities of the TPHCs to identify areas in need of support for strengthening their intersectoral collaboration role in public health at local level. Methods: A mixed-method approach, using qualitative and quantitative techniques, was used to compare the perceptions of all TPHC members (n = 112) and invitees (n = 53) to council meetings from 10 districts covering all geographical areas of Moldova. The quantitative information was obtained using a cross-sectional survey, while the qualitative aspects were assessed within focus group discussions (FGDs). Results: Half of all TPHC members, including 75% from groups with a non-medical background, did not attend a public health course within the last three years. Overall, groups with a medical background were more aware of the legislation that governs TPHC activity and intersectoral collaboration compared with those with a non-medical background. The FGDs of TPHC meetings revealed that members had an insufficient level of understanding of intersectoral collaboration to solve public health issues and lacked clarity about their place and role within the TPHC. Conclusions: HiAP implementation was found to be suboptimal with insufficient capacity at local level. TPHC members' ability to deal with public health issues were severely impaired by a general lack of knowledge and understanding of how to utilize the TPHC platform for maximum benefit. Reforming TPHC regulation is required in addition to extensive capacity building for TPHC members to increase member understanding of their roles as intended by TPHC regulations, including the facilitation of intersectoral collaborations. [ABSTRACT FROM AUTHOR]

The objective of this article was to analyze the factors associated with complex multimorbidity (CMM) among hemodialysis patients in a metropolitan region in southeastern Brazil. To this end, a cross-sectional epidemiological survey was carried out with 1,024 individuals in the year 2019. CMM data were collected through the application of a questionnaire to hemodialysis patients. The binary logistic regression model was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI) between independent variables and CMM. The prevalence of CMM was 81% and the results indicated that: living in cities with a low rate of general mortality (OR = 0.395, 95%CI = 0.179–0.870), being aged between 18 and 29 (OR = 0.402, 95%CI = 0.196–0.825), having an elementary education (OR = 0.536, 95%CI = 0.290–0.966) and assessing health as good/very good (OR = 0.446, 95%CI = 0.301–0.661) are factors that reduced the chances of having CMM, whereas a longer period of hemodialysis (OR = 1.779 and 95%CI = 1.057–2.997) increased the chances of CMM. The findings show that characteristics of the social and individual context are associated with CMM in hemodialysis patients, signaling the need for public health policies that include monitoring the complex multimorbidity condition among individuals undergoing hemodialysis treatment. [ABSTRACT FROM AUTHOR]

Background: In October 2019, cannabis edibles were legalized for sale in Canada for non-medical use. This move was intended to improve public safety by regulating contents (including a maximum 10 mg tetrahydrocannabinol (THC) per package) and packaging to prevent accidental ingestion or over consumption. This study aimed to explore consumer preferences for cannabis edibles to inform cannabis policy. Methods: We explored the relative importance and trade-offs consumers make for attributes of cannabis edibles using a discrete choice experiment. Attributes included type of edible, price, THC content, cannabis taste, package information, product consistency, product recommendations, and Health Canada regulation. Participants lived in Canada, were 19 years of age or older, and purchased a cannabis edible in the last 12 months. A multinomial logit (MNL) model was used for the base model, and latent class analysis to assess preference sub-groups. This study was approved by the institutional ethics committee. Results: Among 684 participants, the MNL model showed that potency was the most relevant attribute, followed by edible type. A two-group latent class model revealed two very distinct preference patterns. Preferences for group 1 (~65% of sample) were driven primarily by edible type, while for group 2 (~35% of sample) were driven almost entirely by THC potency. Conclusion: This study found that consumer preferences for ~65% of consumers of cannabis edibles are being met through regulated channels. The remaining ~35% are driven by THC potency at levels that are not currently available on the licensed market. Attracting this market segment will require reviewing the risks and benefits of restricting THC package content. [ABSTRACT FROM AUTHOR]

Animal hoarding disorder (AHD) is classified as a psychiatric obsessive-compulsive condition characterized by animal accumulation and often accompanied by unsanitary conditions and animal cruelty. Although AHD may increase pathogen transmission and spread, particularly for zoonotic diseases, human and dog exposure in such cases has yet to be fully established. Accordingly, this study aimed to assess Brucella canis in 19 individuals with AHD (11 households) and their 264 dogs (21 households) in Curitiba, the eighth largest city in Brazil, with approximately 1.8 million habitants. Anti-B. canis antibodies were detected by the 2-mercaptoethanol microplate agglutination test (2ME-MAT) and by a commercial lateral flow immunoassay (LFIA), while molecular detection of previously positive seropositive samples was performed by conventional PCR. Although all the human samples were 2ME-MAT negative, 12/264 (4.5%, 95% Confidence Interval: 2.0–7.0%) dog samples were 2ME-MAT and LFIA positive, with 2ME-MAT titers ranging from 20 to 640. At least one dog in 4/21 (19.0%, 95% CI: 2.0–46.0%) households was seropositive. Despite the absence of seropositivity in individuals with AHD and the comparatively low seroprevalence in dogs, B. canis circulation and outbreaks should be considered in such human populations due to the high burden and recurrent character of B. canis exposure in high-density dog populations and the constant introduction of susceptible animals. Author summary: Individuals with animal hoarding disorder (AHD), a psychiatric obsessive-compulsive disorder, are considered among the most vulnerable people due to their precarious sanitary conditions and exposure to several zoonoses, including canine brucellosis, a neglected and underreported disease of public health concern worldwide. Close and continuous human contact with unhealthy and unassisted dogs may increase pathogen transmission and spread, which is worsened by elderly people's difficulty accessing health services and lack of hoarding control and management programs. The present study assessed B. canis as a silent pathogen in this hard-to-access vulnerable population, along with their dogs. Although all the individuals with AHD included herein were seronegative and their dogs presented relatively low seroprevalence, B. canis infection and outbreaks should always be considered, particularly due to unsanitary household conditions, the high density of dog populations, and the constant introduction of susceptible dogs of unknown origin. Thus, dogs seropositive for B. canis living in households of people with AHD should be considered a warning to local public health authorities. In conclusion, serological and molecular assessments of B. canis in people with AHD and other vulnerable populations may serve as instruments for effective public health policies, including diagnosis, control, monitoring, and prevention. [ABSTRACT FROM AUTHOR]

Background: Colistin serves as the last line of defense against multidrug resistant Gram-negative bacterial infections in both human and veterinary medicine. This study aimed to investigate the occurrence and spread of colistin-resistant Enterobacterales (ColR-E) using a One Health approach in Belgium and in the Netherlands. Methods: In a transnational research project, a total of 998 hospitalized patients, 1430 long-term care facility (LTCF) residents, 947 children attending day care centres, 1597 pigs and 1691 broilers were sampled for the presence of ColR-E in 2017 and 2018, followed by a second round twelve months later for hospitalized patients and animals. Colistin treatment incidence in livestock farms was used to determine the association between colistin use and resistance. Selective cultures and colistin minimum inhibitory concentrations (MIC) were employed to identify ColR-E. A combination of short-read and long-read sequencing was utilized to investigate the molecular characteristics of 562 colistin-resistant isolates. Core genome multi-locus sequence typing (cgMLST) was applied to examine potential transmission events. Results: The presence of ColR-E was observed in all One Health sectors. In Dutch hospitalized patients, ColR-E proportions (11.3 and 11.8% in both measurements) were higher than in Belgian patients (4.4 and 7.9% in both measurements), while the occurrence of ColR-E in Belgian LTCF residents (10.2%) and children in day care centres (17.6%) was higher than in their Dutch counterparts (5.6% and 12.8%, respectively). Colistin use in pig farms was associated with the occurrence of colistin resistance. The percentage of pigs carrying ColR-E was 21.8 and 23.3% in Belgium and 14.6% and 8.9% in the Netherlands during both measurements. The proportion of broilers carrying ColR-E in the Netherlands (5.3 and 1.5%) was higher compared to Belgium (1.5 and 0.7%) in both measurements. mcr-harboring E. coli were detected in 17.4% (31/178) of the screened pigs from 7 Belgian pig farms. Concurrently, four human-related Enterobacter spp. isolates harbored mcr-9.1 and mcr-10 genes. The majority of colistin-resistant isolates (419/473, 88.6% E. coli; 126/166, 75.9% Klebsiella spp.; 50/75, 66.7% Enterobacter spp.) were susceptible to the critically important antibiotics (extended-spectrum cephalosporins, fluoroquinolones, carbapenems and aminoglycosides). Chromosomal colistin resistance mutations have been identified in globally prevalent high-risk clonal lineages, including E. coli ST131 (n = 17) and ST1193 (n = 4). Clonally related isolates were detected in different patients, healthy individuals and livestock animals of the same site suggesting local transmission. Clonal clustering of E. coli ST10 and K. pneumoniae ST45 was identified in different sites from both countries suggesting that these clones have the potential to spread colistin resistance through the human population or were acquired by exposure to a common (food) source. In pig farms, the continuous circulation of related isolates was observed over time. Inter-host transmission between humans and livestock animals was not detected. Conclusions: The findings of this study contribute to a broader understanding of ColR-E prevalence and the possible pathways of transmission, offering insights valuable to both academic research and public health policy development. [ABSTRACT FROM AUTHOR]

Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases—Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular. [ABSTRACT FROM AUTHOR]

A diagnosis of cancer impacts the person's physical and mental health and the psychosocial and financial health of their caregivers. While data on the experience of living with cancer is available, there is a dearth of data from persons in low- and middle-income countries (LMICs). The perspectives of other impacted individuals also remain understudied (e.g., bereaved family members), as well as the impact on survivors and their families over time. The objective of this study is to describe the psychosocial and financial impact of cancer on people diagnosed with cancer as a child, adolescent or adult, their families/caregivers, and the family members of those who have died from cancer, in high-income countries (HICs) and LMICs. This study is an observational, descriptive, quantitative study. Data will be collected anonymously via a digital online cross-sectional survey distributed globally by the World Health Organization (WHO) via the LimeSurvey software. Participants will include (a) adults aged 18+ who have been diagnosed with cancer at any age, who are currently undergoing cancer treatment or who have completed cancer treatment; (b) adult family members of individuals of any age with a cancer diagnosis, who are currently undergoing cancer treatment or who have completed cancer treatment; and (c) bereaved family members. Participants will be anonymously recruited via convenience and snowball sampling through networks of organisations related to cancer. Survey results will be analysed quantitatively per respondent group, per time from diagnosis, per disease and country. Results will be disseminated in peer-reviewed journals and at scientific conferences; a summary of results will be available on the WHO website. This study will suggest public health interventions and policy responses to support people affected by cancer and may also lead to subsequent research focusing on the needs of people affected by cancer. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic highlights the pressing need for constant surveillance, updating of the response plan in post-peak periods and readiness for the possibility of new waves of the pandemic. A short initial period of steady rise in the number of new cases is sometimes followed by one of exponential growth. Systematic public health surveillance of the pandemic should signal an alert in the event of change in epidemic activity within the community to inform public health policy makers of the need to control a potential outbreak. The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with a new surveillance metric to overcome some of their difficulties in capturing the changing dynamics of the pandemic. At statistically-founded threshold values, the new measure will trigger alert signals giving early warning of the onset of a new pandemic wave. We define a new index, the weighted cumulative incidence index, based on the daily new-case count. We model the infection spread rate at two levels, inside and outside homes, which explains the overdispersion observed in the data. The seasonal component of real data, due to the public surveillance system, is incorporated into the statistical analysis. Probabilistic analysis enables the construction of a Control Chart for monitoring index variability and setting automatic alert thresholds for new pandemic waves. Both the new index and the control chart have been implemented with the aid of a computational tool developed in R, and used daily by the Navarre Government (Spain) for virus propagation surveillance during post-peak periods. Automated monitoring generates daily reports showing the areas whose control charts issue an alert. The new index reacts sooner to data trend changes preluding new pandemic waves, than the standard surveillance index based on the 14-day notification rate of reported COVID-19 cases per 100,000 population. [ABSTRACT FROM AUTHOR]

The mortality impact of COVID-19 has mainly been studied at the national level. However, looking at the aggregate impact of the pandemic at the country level masks heterogeneity at the subnational level. Subnational assessments are essential for the formulation of public health policies. This is especially important for federal countries with decentralised healthcare systems, such as Germany. Therefore, we assess geographical variation in the mortality impact of COVID-19 for the 16 German federal states in 2020 and 2021 and the sex differences therein. For this purpose, we adopted an ecological study design, using population-level mortality data by federal state, age, and sex, for 2005–2021 obtained from the German Federal Statistical Office. We quantified the impact of the pandemic using the excess mortality approach. We estimated period life expectancy losses (LE losses), excess premature mortality, and excess deaths by comparing their observed with their expected values. The expected mortality was based on projected age-specific mortality rates using the Lee-Carter methodology. Saxony was the most affected region in 2020 (LE loss 0.77 years, 95% CI 0.74;0.79) while Saarland was the least affected (-0.04, -0.09;0.003). In 2021, the regions with the highest losses were Thuringia (1.58, 1.54;1.62) and Saxony (1.57, 1.53;1.6) and the lowest in Schleswig-Holstein (0.13, 0.07;0.18). Furthermore, in 2021, eastern regions experienced higher LE losses (mean: 1.13, range: 0.85 years) than western territories (mean: 0.5, range: 0.72 years). The regional variation increased between 2020 and 2021, and was higher among males than among females, particularly in 2021. We observed an unequal distribution of the mortality impact of COVID-19 at the subnational level in Germany, particularly in 2021 among the male population. The observed differences between federal states might be partially explained by the heterogeneous spread of the virus in 2020 and by differences in the population's propensity to follow preventive guidelines. [ABSTRACT FROM AUTHOR]

The impact of the COVID-19 pandemic on University students has been a topic of fiery debate and of public health research. This study demonstrates the use of a combination of spatiotemporal epidemiological models to describe the trends in COVID-19 positive cases on spatial, temporal and spatiotemporal scales. In addition, this study proposes new epidemiological metrics to describe the connectivity between observed positivity; an analogous metric to the R number in conventional epidemiology. The proposed indices, Rspatial, Rspatiotemporal and Rscaling will aim to improve the characterisation of the spread of infectious disease beyond that of the COVID-19 framework and as a result inform relevant public health policy. Apart from demonstrating the application of the novel epidemiological indices, the key findings in this study are: firstly, there were some Intermediate Zones in Edinburgh with noticeably high levels of COVID-19 positivity, and that the first outbreak during the study period was observed in Dalry and Fountainbridge. Secondly, the estimation of the distance over which the COVID-19 counts at the halls of residence are spatially correlated (or related to each other) was found to be 0.19km (0.13km to 0.27km) and is denoted by the index, Rspatial. This estimate is useful for public health policy in this setting, especially with contact tracing. Thirdly, the study indicates that the association between the surrounding community level of COVID-19 positivity (Intermediate Zones in Edinburgh) and that of the University of Edinburgh's halls of residence was not statistically significant. Fourthly, this study reveals that relatively high levels of COVID-19 positivity were observed for halls for which higher COVID-19 fines were issued (Spearman's correlation coefficient = 0.34), and separately, for halls which were non-ensuite relatively to those which were not (Spearman's correlation coefficient = 0.16). Finally, Intermediate Zones with the highest positivity were associated with student residences that experienced relatively high COVID-19 positivity (Spearman's correlation coefficient = 0.27). [ABSTRACT FROM AUTHOR]

Background: Recent studies have suggested that the COVID-19 pandemic has increased existing health challenges experienced by transgender (trans) and non-binary people. Additionally, COVID-19 has also negatively impacted youth mental health. However, the impact of the COVID-19 pandemic with respect to the intersection of youth and trans and non-binary populations is currently not well established. The present longitudinal qualitative study aimed to examine the evolving challenges experienced by trans and non-binary youth during the COVID-19 pandemic. Methods: Gender-diverse youth, defined as participants who did not identify as cisgender in April 2020, were invited to participate from among the participant pool of a COVID-19 cohort study in Canada. Qualitative interviews were conducted in August 2020, January 2021, and August 2021, during the first year and a half of the COVID-19 pandemic. Qualitative themes were identified based on reflexive thematic analysis and plot-line narrative inquiry. Results: Ten participants aged 18 to 28 were included in the present analysis, yielding 29 transcripts. We identified themes of (1) losses of connection to gender-diverse communities, (2) changes in gender identity, affirmation, and self-reflection, (3) a dual burden of trans and non-binary specific health and service access challenges as well as COVID-19 pandemic related health challenges, and (4) virtually rebuilding gender-diverse communities during the COVID-19 pandemic. Conclusions: Gender-diverse youth may experience unique challenges during the COVID-19 pandemic. The losses with gender-diverse communities may further isolate queer people from access to healthcare, housing, and employment. Public health policy targeted at gender-diverse youth may consider addressing "upstream" disparities in healthcare and housing in order to support the rebuilding of queer and gender-diverse communities by gender-diverse people. [ABSTRACT FROM AUTHOR]

Objective: To investigate public willingness to share sensitive health information for research, health policy and clinical practice. Methods: A total of 1,003 Australian respondents answered an online, attribute-driven, survey in which participants were asked to accept or reject hypothetical choice sets based on a willingness to share their health data for research and frontline-medical support as part of an integrated health system. The survey consisted of 5 attributes: Stakeholder access for analysis (Analysing group); Type of information collected; Purpose of data collection; Information governance; and Anticipated benefit; the results of which were analysed using logistic regression. Results: When asked about their preference for sharing their health data, respondents had no preference between data collection for the purposes of clinical practice, health policy or research, with a slight preference for having government organisations manage, govern and curate the integrated datasets from which the analysis was being conducted. The least preferred option was for personal health records to be integrated with insurance records or for their data collected by privately owned corporate organisations. Individuals preferred their data to be analysed by a public healthcare provider or government staff and expressed a dislike for any private company involvement. Conclusions: The findings from this study suggest that Australian consumers prefer to share their health data when there is government oversight, and have concerns about sharing their anonymised health data for clinical practice, health policy or research purposes unless clarity is provided pertaining to its intended purpose, limitations of use and restrictions to access. Similar findings have been observed in the limited set of existing international studies utilising a stated preference approach. Evident from this study, and supported by national and international research, is that the establishment and preservation of a social license for data linkage in health research will require routine public engagement as a result of continuously evolving technological advancements and fluctuating risk tolerance. Without more work to understand and address stakeholder concerns, consumers risk being reluctant to participate in data-sharing and linkage programmes. [ABSTRACT FROM AUTHOR]

Background: Post-lingual deafness represents a critical challenge for adults' well-being with substantial public health burdens. One treatment of choice has been cochlear implants (CI) for people with severe to profound hearing loss (HL). Since 2018, Chile has implemented a high-cost policy to cover CI treatment, the "Ley Ricarte Soto" (LRS) health policy. However, wide variability exists in the use of this device. To date, no related study has been published on policy evaluation in Chile or other Latin American countries. Objectives: This study aimed to evaluate the impact of the LRS policy on the treatment success and labour market inclusion among deaf or hard of hearing (DHH) adults using CI. We examined and characterised outcomes based on self-reports about treatment success and occupation status between 2018 and 2020. Design: We performed a prospective study using hospital clinical records and an online questionnaire with 76 DHH adults aged >15 who had received CIs since the introduction of the LRS policy in 2018. Using univariate and multivariate regression models, we investigated the relationship between demographic, audiological, and social determinants of health and outcomes, including treatment success for social inclusion (International Outcome inventory for Hearing Aids and CIs assessment: IOI-HA) and occupation status for labour market inclusion. Results: Our study showed elevated levels of treatment success in most of the seven sub-scores of the IOI-HA assessment. Similarly, around 70% of participants maintained or improved their occupations after receiving their CI. We found a significant positive association between treatment success and market inclusion. Participants diagnosed at younger ages had better results than older participants in both outcomes. Regarding social determinants of health, findings suggested participants with high social health insurance and a shorter commute time to the clinic had better results in treatment success. For labour market inclusion, participants with high education levels and better pre- CI occupation had better post-CI occupation status. Conclusions: In evaluating the LRS policy for providing CIs for DHH adults in Chile, we found positive effects relating to treatment success and occupation status. Our study supports the importance of age at diagnosis and social determinants of health, which should be assessed by integrating public services and bringing them geographically closer to each beneficiary. Although evidence-based guidelines for candidate selection given by the LRS policy might contribute to good results, these guidelines could limit the policy access to people who do not meet the requirements of the guidelines due to social inequalities. [ABSTRACT FROM AUTHOR]

Background: Because public health policies lay down guidelines for health promotion in specific populations, a review of policies devised for children and youth with special health care needs (CYSHCN) can reveal the actual degree of priority assigned to this population segment, while also highlighting relevant policies in this field. Objective: To map the available evidence of public health policies for CYSHCN in member countries of the Organization for Economic Cooperation and Development (OECD) and Brazil. Method: A scoping review protocol was developed as per the Joanna Briggs Institute (JBI) manual and the Preferred Reporting Items for Systematic Review and Meta-Analyses–Extension for Scoping Reviews (PRISMA-ScR) checklist, for application to the Web of Science (WoS), Scopus, PubMed, and Embase databases;to theLatin American and Caribbean Literature in Health Sciences (LILACS)multilingual thesaurus; and to gray literature.The review will map the principal documents (irrespective of time frame or language) addressing public health policies for CYSHCN up to 19 years old. The research protocol has been registered on the Open Science Framework platform (identifier 10.17605/OSF.IO/UW5BH:DOI). Results and conclusion: Tables, maps, charts, and/or graphs accompanied by descriptive texts will be employed to present the results to the research question and provide answers to it. Use of both open-access software IRaMuTeQ for similitude analysis and word clouds is also planned. This protocol is expected to reveal policies that meet the specific needs of this vulnerable population segment and highlight examples of good practices or current gaps. [ABSTRACT FROM AUTHOR]

In May 2022, a cluster of mpox cases were detected in the UK that could not be traced to recent travel history from an endemic region. Over the coming months, the outbreak grew, with over 3000 total cases reported in the UK, and similar outbreaks occurring worldwide. These outbreaks appeared linked to sexual contact networks between gay, bisexual and other men who have sex with men. Following the COVID-19 pandemic, local health systems were strained, and therefore effective surveillance for mpox was essential for managing public health policy. However, the mpox outbreak in the UK was characterised by substantial delays in the reporting of the symptom onset date and specimen collection date for confirmed positive cases. These delays led to substantial backfilling in the epidemic curve, making it challenging to interpret the epidemic trajectory in real-time. Many nowcasting models exist to tackle this challenge in epidemiological data, but these lacked sufficient flexibility. We have developed a nowcasting model using generalised additive models that makes novel use of individual-level patient data to correct the mpox epidemic curve in England. The aim of this model is to correct for backfilling in the epidemic curve and provide real-time characteristics of the state of the epidemic, including the real-time growth rate. This model benefited from close collaboration with individuals involved in collecting and processing the data, enabling temporal changes in the reporting structure to be built into the model, which improved the robustness of the nowcasts generated. The resulting model accurately captured the true shape of the epidemic curve in real time. Author summary: During 2022, outbreaks of mpox, the disease caused by the monkeypox virus, occurred simultaneously in multiple non-endemic countries, including England. These outbreaks were distinct from historic outbreaks with a majority of cases in gay, bisexual and other men who have sex with men and in individuals without recent travel histories to endemic countries. To inform public health policy, understanding the number of new cases and growth rate of the outbreak in real-time is essential. However, the outbreak was characterised by long delays from individuals developing symptoms (or getting a test) and being reported as a positive case. This creates a biased picture of the outbreak, where observed real-time cases underestimates the true extent of the outbreak. We developed a mathematical model that accounts for these reporting delays to estimate the true shape of the epidemic curve in real-time. The modelled outputs are able to accurately capture the true shape of the epidemic, and provide improved real-time insight over the raw data. This model was used continuously throughout the outbreak response in the UK to provide insight to the incident management team at the UK Health Security Agency. [ABSTRACT FROM AUTHOR]

Heterogeneity in contact patterns, mortality rates, and transmissibility among and between different age classes can have significant effects on epidemic outcomes. Adaptive behavior in response to the spread of an infectious pathogen may give rise to complex epidemiological dynamics. Here we model an infectious disease in which adaptive behavior incentives, and mortality rates, can vary between two and three age classes. The model indicates that age-dependent variability in infection aversion can produce more complex epidemic dynamics at lower levels of pathogen transmissibility and that those at less risk of infection can still drive complexity in the dynamics of those at higher risk of infection. Policymakers should consider the interdependence of such heterogeneous groups when making decisions. Author summary: Behavior during epidemics is driven by incentives, which may vary among the different age classes. Here we include age-differentiated incentives in an adaptive behavioral epidemic model with two and three age classes. Our results indicate that this heterogeneity can drive the system into oscillations, chaos, and collapse. Those with less incentives to adopt protective behavior for themselves (i.e., the youth) can still drive epidemic dynamics and associated complexity in those who have more incentives to avoid contacts during epidemics (i.e., the elderly). This heterogeneity and interdependence should be taken into account when making public health policy that affects individual contact rates during an epidemic. [ABSTRACT FROM AUTHOR]

Background: Public health policies designed to influence individuals' infection-control behaviour are a tool for governments to help prevent the spread of disease. Findings on the impacts of policies are mixed and there is limited information on the effects of removing restrictions and how policies impact behavioural trends. Methods: We use low-acuity emergency department visits from 12 hospitals in New Brunswick, Canada, (January 2017 –October 2021) as a proxy for infection-control behaviour and provide insight into the effects of the COVID-19 virus on a population with a low prevalence of cases. Quasi-experimental techniques (event studies) are applied to estimate the magnitude and persistence of effects of specific events (e.g., policy changes), to control for COVID-19 cases and vaccines, and to explore how the effectiveness of policy changes during the pandemic as more policies are introduced. Results: Initial tightening of restrictions on March 11, 2020 reduced low-acuity emergency department visits by around 60% and reached a minimum after 30 days. Relaxing policies on social gatherings and personal services gradually increased low-acuity emergency department visits by approximately 50% after 44 days. No effects were found from policies lifting all restrictions, and reinstating a state of emergency on July 31, 2021, and September 24, 2021. Conclusion: These results suggest that policy interventions are less likely to be effective at influencing infection control behaviour with time and more policies introduced, and that tracking and publicly reporting case numbers can influence infection control behaviour. [ABSTRACT FROM AUTHOR]